Reducing the risk of heart disease and stroke

How does metabolic syndrome affect the functional ambulation in stroke patients?

BACKGROUND/AIMS

Metabolic syndrome (MetS) is a risk factor for stroke. However, the role of MetS in stroke rehabilitation has not been assessed. The aim of this study was to evaluate the impact of MetS on rehabilitation from stroke.

MATERIALS AND METHODS

A total of 337 consecutive patients with subacute stroke and 220 age-matched healthy controls were studied. The diagnosis of MetS was based on the criteria of the National Cholesterol Education Program Adult Treatment Panel III. Ambulation levels were evaluated using the Functional Ambulation Classification (FAC) measure. The correlation between MetS and FAC was investigated. The regression analysis included presence of hypertriglyceridemia, high fasting glucose, low high-density lipoprotein cholesterol, hypertension, abdominal obesity, MetS, and age ≯65 years.

RESULTS

The prevalence of MetS in the control group and the ischemic and hemorrhagic stroke groups was 33.2% (n = 73), 59.8% (n = 156), and 68.4% (n = 52), respectively. MetS prevalence was significantly higher in stroke groups compared with the control group (P < .001). FAC and MetS were significantly and negatively correlated in the stroke groups (P < .001, rho = -0.387, for hemorrhagic stroke;P < .001, rho = -0.379, for ischemic stroke). Multivariable logistic regression analysis demonstrated that diastolic tension, MetS presence, and age were found to be independent risk factors for FAC in ischemic stroke groups.

CONCLUSIONS

MetS is associated with worse functional ambulation for both ischemic and hemorrhagic stroke patients. Aggressive rehabilitation can be advocated in the presence of MetS in ischemic stroke patients.

Mood and Balance are Associated with Free-Living Physical Activity of People after Stroke Residing in the community

Purpose. To determine which characteristics are most associated with free-living physical activity in community-dwelling ambulatory people after stroke. Method. Factors (age, gender, side of stroke, time since stroke, BMI, and spouse), sensory-motor impairments (weakness, contracture, spasticity, coordination, proprioception, and balance), and non-sensory-motor impairments (cognition, language, perception, mood, and confidence) were collected on 42 people with chronic stroke. Free-living physical activity was measured using an activity monitor and reported as time on feet and activity counts. Results. Univariate analysis showed that balance and mood were correlated with time on feet (r = 0.42, 0.43, P < 0.01) and also with activity counts (r = 0.52, 0.54, P < 0.01). Stepwise multiple regression showed that mood and balance accounted for 25% of the variance in time on feet and 40% of the variance in activity counts. Conclusions. Mood and balance are associated with free-living physical activity in ambulatory people after stroke residing in the community.

Duration of physical activity is normal but frequency is reduced after stroke: an observational study

QUESTION

What is the free-living physical activity of community-dwelling people with stroke compared with that of age-matched healthy controls?

DESIGN

A cross-sectional observational study.

PARTICIPANTS

42 people with stroke and 21 age-matched healthy controls aged 52 to 87 years living in Sydney, Australia.

OUTCOME MEASURES

Free-living physical activity was measured using the Intelligent Device for Energy Expenditure and Activity (IDEEA) and reported as duration (time on feet in min) and frequency (activity counts).

RESULTS

People with stroke spent 79 (95% CI 20 to 138) fewer min on their feet and performed 5308 (95% CI 3171 to 7445) fewer activity counts than healthy controls. The observation period of the free-living physical activity of stroke survivors was significantly less than that of the healthy controls. Data adjusted to a fixed observation period (12 hr) showed no relative difference in time on feet between the groups (mean difference 36 min, 95% CI -27 to 99) but that people after stroke still had relatively fewer activity counts than healthy controls (mean difference 4062 counts, 95% CI 1787 to 6337).

CONCLUSIONS

The reduction in physical activity after stroke is not primarily because of a decrease in the time spent being active but rather a decrease in frequency of activity during that time. Future research into physical activity after stroke needs to consider energy expenditure because stroke survivors exhibit a reduced frequency of physical activity due to the nature of their impairments.